New Study Links Between Nurse's Criminal History and Professional Misconduct

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A study published in the March issue of the American Journal of Nursing (AJN) found that almost 40% of nurses who were on probation for professional misconduct in 2001 committed another act of misconduct between 2001 and 2005. Nurses on probation who had a history of criminal conviction were more likely to recidivate, suggesting that licensing boards should carefully screen and monitor nurses with a criminal background.

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The study was conducted by the National Council of State Boards of Nursing (NCSBN). AJN, the leading voice of nursing since 1900, is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

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"We hope that the study's findings will be used to help shape regulatory policies and develop disciplinary programs targeted to individual nurses," said Elizabeth H. Zhong, PhD, research associate, National Council of State Boards of Nursing in Chicago and an author of the study. "Our hope is that further quantitative research of professional disciplinary action will lead to more effective remediation programs to protect public health and safety."

According to the study, the recidivism rate among those with a history of criminal conviction (56%; 22 of 39 nurses) was nearly twice as high as the rate among those without such a history (33%; 24 of 73). Thirty-three percent of the disciplined nurses changed employers during their probation; the recidivism rate among them was more than twice the rate among the disciplined nurses who stayed with the same employer.

The proportion of men who had been disciplined was more than twice the proportion of men in the national nursing workforce, and younger nurses (both men and women) were also more likely to recidivate: among those who were younger than 40, 49% recidivated, while 34% of those who were 40 years old or older.

Protecting the public from incompetent or otherwise unsafe nursing practice is a responsibility of state boards of nursing. Boards of nursing can place nurses who have committed practice-related violations on probation, limiting their practice to particular settings or placing them under certain conditions for a specified time. The state boards also aim to help nurses who have been disciplined return to nursing practice through remediation.

While the number and percentage of nurses sanctioned by state boards of nursing has risen in the last decade, there have been few nationwide studies about the characteristics of nurses who have been disciplined, outcomes of remediation or the putative risk factors for violation and recidivism.

In 2006, the National Council of State Boards of Nursing (NCSBN), working with six state nursing boards, (Arizona, Marlyand, Massachusetts, Minnesota, Nebraska and North Carolina) initiated an exploratory study to evaluate the characteristics of nurses who had been disciplined and the factors that might affect the outcomes of remediation.

A 29-item questionnaire was used to investigate the records of 207 RNs, LPNs, and advanced practice RNs (APRNs) who were disciplined and put on probation by a state nursing board in 2001 as well as to collect data on their employment settings, the boards' actions and remediation outcomes (the presence or absence of recidivism); 491 nurses who had not been disciplined served as controls.

Among the disciplined nurses studied, 57% were RNs, 36% were LPNs, 3% held both RN and LPN licenses and 3% were APRNs. Data on history of criminal conviction prior to state board disciplinary action were available for 112 (54%) of the 207 nurses. Among those 112, 35% (n=39) had a history of criminal conviction, whereas only 3% of the control group reported one.

"This is a very complex issue and more work still needs to be done to study this problem," said Diana Mason, PhD, RN, FAAN and editor-in-chief of AJN. "We need to build a system of evidence-based nationwide policies and procedures that will ensure that licensure boards are able to protect the public in consistent, accountable ways. Through this study, the National Council of State Boards for Nursing has provided evidence that can contribute to such an achievement."

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